‘If I was a horse, they would have shot me by now’

Mike Fulton, here with his assistance dog Cody, was the first HIV-positive patient in Canada to receive a kidney transplant.Jason Payne
/ PROVINCE

Dr. David Landsberg is head of both the St. Paul’s and provincial renal transplant programs.Jason Payne
/ PROVINCE

The first thing you should know about groundbreaking kidney transplant patient Mike Fulton is that he is positive.

The Vancouver resident made Canadian history when he became the country’s very first HIV-positive transplant patient in 2005. His kidney transplant surgery, performed at St. Paul’s hospital, has since paved the way for other positive patients, saving lives in the process.

But it’s not that kind of positive that defines Fulton.

Rather his optimism, good humour and cheerfulness are what mark him as exceptional. That positive outlook is a deliberate decision to enjoy life despite a series of devastating health crises.

“If I was a horse, they would have shot me by now,” he joked in characteristic fashion, as his guide dog Cody dozed at his feet on the hospital floor.

The 45-year-old was diagnosed first with diabetes in the mid-1980s, then with HIV in 1990. In 1998, he suffered simultaneous retinal hemorrhages in both his eyes, and although they tried, St. Paul’s surgeons couldn’t save his sight. By 31, he was blind.

Only a month after being discharged from the hospital he noticed a small lesion on his foot. It was necrotizing fasciitis — flesh eating disease. Doctors blasted his system with heavy antibiotics. They saved his foot, but his kidneys paid the price.

“Unfortunately, the side effect to those antibiotics was pushing my already not so great kidneys over the edge,” Fulton recalled. “They basically shut down.”

Exhausted from his “year of hell,” he had yet another blow to endure: he was told that as an HIV-positive patient, he could never be a candidate for a kidney transplant.

To that point, such transplants had never been done in Canada. American hospitals had marginal results, at best. The problem was people with HIV have suppressed immune systems. Transplant recipients must take even more immuno-suppressant drugs to prevent organ rejection, leaving patients vulnerable to life-threatening infection and viruses.

Fulton reluctantly began dialysis, but he was not deterred. “I don’t like being told no. I thought, ‘why aren’t they doing it?’”

His physicians were thinking the same thing. Better anti-retroviral drug cocktails could now reduce patient viral loads to nearly zero, reducing the risk to an HIV transplant patients’ system. And St. Paul’s, as the provincial centre for renal care and a centre of excellence for HIV/AIDS treatment, was uniquely positioned to manage the treatment of such a complex case and carefully monitor post-transplant drug interactions.

So after much research and preparation, he was approved to go on the waiting list.

“They didn’t want to do this just haphazardly. They wanted to be successful, and I don’t blame them,” he said of the long wait.

“It was such a group effort. I wouldn’t be here if it wasn’t for them.”

In early 2005, he got what he was waiting for.

• • •

“It was a big deal,” St. Paul’s nephrologist Dr. David Landsberg, head of the hospital and provincial renal transplant programs, said of the historic surgery. “Most transplant centres were unwilling to do them. At the time, we didn’t want to sensationalize it, but we were proud that we were able to do something that other people weren’t doing, to allow other centres to go ahead and do it as well.”

It wasn’t the first time St. Paul’s showed national leadership in renal transplants and care.

In 1999, they performed the first simultaneous heart and kidney transplant in B.C. history.

In 2003, Dr. Landsberg said, the hospital became the first in the country to use non-directed anonymous donors — living donors who offer up a kidney to the system out of pure altruism, unconnected to a planned recipient — in kidney transplants. They are now routinely used in paired exchange transplant chains nationally.

In 2004, they also performed B.C.’s first minimally-invasive laparoscopic procedure to remove a kidney from a living donor, now standard practice. St. Paul’s has performed more than 1,950 kidney transplants since the first one was done in 1986 on a father of two from Prince Rupert.

And thanks to Fulton’s willingness to be a test case for the surgery in HIV-positive patients, five other HIV-positive patients have since been able to have transplants of their own.

• • •

Fulton’s new kidney, implanted in February 2005, got off to a slow start. But on March 21, Fulton woke to a strange sensation.

“I couldn’t figure out what it was. Suddenly, it hit me. I had to go pee. I hadn’t peed in six years,” he joked. “I’d totally forgotten how.”

His new kidney lasted for over four years, until it flagged and he began dialysis again in late 2009. But he was able to have a second successful transplant in March 2010, on his birthday. His health, he says, is infinitely better, “like night and day.” Fulton’s bright outlook no doubt played a role in his recovery.

“When life kicks you to the ground, you have two choices: you can curl up in a corner and cry about it or you can pick yourself up and brush yourself off and get on with it. So that’s the route that I chose. I got on with it. And I am so glad that I did.”

Yet Fulton is modest when it comes to his contribution to St. Paul’s innovations.

“Being the guinea pig, I was scared … because all the cases I’d read about in the States … [few] survived or if they did it was very short-lived. I hadn’t even considered that by me doing what I did, all these people after me are going to have the same opportunity.”

Instead, the medical pioneer simply followed his instincts:“I had a feeling it was meant to be,” he said. “I’m very positive about this.”

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